目的:本研究旨在探讨二甲双胍用于控制糖尿病前期患者向糖尿病过渡的最佳剂量。
方法:我们系统地检索了中国知网中的随机对照试验(RCT),万方,VIP,SinoMed,Scopus,PubMed,Embase,科克伦图书馆,WebofScience,从开始到2024年2月的护理和相关健康文献累积指数(CINAHL)。采用RevMan5.4软件进行Meta分析。
结果:我们纳入了25项随机对照试验,包括2437例患者。荟萃分析结果显示,与500mg/d的剂量组相比,850毫克/天,1000mg/d,1500mg/d,1700mg/d,和2000毫克/天,剂量为750mg/d的二甲双胍可显著降低患者糖尿病的发病率(风险比[RR]=0.21,95%置信区间[CI]:0.11,0.41;p<0.00001),降低餐后血糖(PBG)(平均差异[MD]=-2.60,95%CI:-4.34,-0.86;p=0.003),并促进血糖水平的正常化(RR=2.13,95%CI:1.68,2.71;p<0.00001)。关于安全评估,在各剂量组之间没有发现显著差异.相比之下,每日剂量为750mg的队列显示不良反应发生率下降最明显.
结论:根据疗效和安全性评价结果,我们的研究结果表明,二甲双胍每日剂量750mg可能是控制糖尿病前期至糖尿病进展的最佳剂量.
背景:PROSPERO注册ID:CRD42024538322。
OBJECTIVE: This study aims to investigate the optimal dose of metformin for controlling the transition to diabetes in patients diagnosed with prediabetes.
METHODS: We systematically searched randomized controlled trials (RCTs) in CNKI, Wanfang, VIP, SinoMed, Scopus, PubMed, Embase, Cochrane Library, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception to February 2024. Meta-analysis was conducted using RevMan 5.4 software.
RESULTS: We included 25 randomized controlled trials comprising 2437 patients. The results of the meta-analysis revealed that compared to dose groups of 500 mg/d, 850 mg/d, 1000 mg/d, 1500 mg/d, 1700 mg/d, and 2000 mg/d, a dosage of 750 mg/d of metformin significantly reduced the incidence of diabetes in patients (risk ratio [RR] = 0.21, 95 % confidence interval [CI]: 0.11, 0.41; p < 0.00001), lowered Postprandial Blood Glucose (PBG) (mean difference[MD] = -2.60, 95 % CI: -4.34, -0.86; p = 0.003), and promoted the normalization of blood glucose levels (RR = 2.13, 95 % CI: 1.68, 2.71; p < 0.00001). Regarding safety evaluation, no significant differences were identified among the various dose groups. In contrast, the cohort receiving a daily dosage of 750 mg demonstrated the most pronounced decrease in the incidence of adverse reactions.
CONCLUSIONS: Based on the efficacy and safety evaluation results, our findings suggest that a daily dosage of 750 mg of metformin may represent the optimal dose for controlling the progression from pre-diabetes to diabetes.
BACKGROUND: PROSPERO registration ID: CRD42024538322.